SAN PABLO -- One day after a parcel tax proposal to save Doctors Medical Center was rejected by voters, Contra Costa public health leaders and politicians started the grim process of planning for the hospital's likely closure this summer and the resulting impact on public health in West County.

"I'm not anticipating any miracles," Dr. William Walker, Contra Costa County's top health official, said Wednesday morning. "I think we have understood for a long time that the only way to keep DMC open was a successful ballot measure, and we now face the scenario of dealing with the closure and minimizing harm. That is the task before us."

Maria Sahagun, an emergency room nurse, talks about the fate of Doctors Medical Center after voters rejected a tax to save the hospital in San Pablo, Calif. on Wednesday, May 7, 2014. (Kristopher Skinner/Bay Area News Group)

Measure C, a mail-in parcel tax measure, would have levied a 14 cent-per-square-foot tax on all property in the West Contra Costa Healthcare District, which stretches along Interstate 80 from Kensington to Crockett. Only 51.9 percent of voters -- about 16,000 residents -- supported the tax, which needed two-thirds approval.

"District voters have spoken," Eric Zell, chairman of the West Contra Costa Healthcare District, which owns DMC, said in a statement. "Given the unsustainable operating losses -- and despite all of our efforts to cut costs and bring in new revenue -- it is now incumbent on hospital leadership and medical staff to prepare for an orderly closure and to work with county public health officials on transition of patient care."

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Doctors Medical Center operates the area's largest emergency room, seeing 40,000 patients a year, and provides all of West County's specialized heart attack and stroke care and an array of other acute and critical care services.

Walker said the nearby hospitals that would be most immediately affected by DMC's closure are Summit Alta Bates in Berkeley and John Muir in Concord, which have stroke and heart attack emergency facilities that could handle the patients that now come to DMC with those life-threatening conditions.

He added that finding alternative health care options for DMC's roughly 100 walk-up patients per day will require extensive planning by county health officials, including expanding the county's advice nurse hotline and urging nearby hospitals to take more primary care patients.

Kaiser Permanente's Richmond campus operates the only other emergency room in West Contra Costa, but it has only 15 beds compared with 25 at DMC.

"We are going to talk to Kaiser Richmond about increasing their same-day appointment capacity for non-Kaiser members," Walker said. "We are all going to ask everyone to step up to the plate."

Unions representing some of the 900-plus workers at the hospital are not giving up hope. Nurses with the California Nurses Association gathered outside the hospital early Wednesday to call on the county to take ownership of the hospital and provide the funds needed to keep it open.

"We don't understand the politics, but we know the county has an obligation to ensure the indigent of West County can receive adequate medical care," said Maria Sahagun, an ER nurse at DMC for six years.

Contra Costa officials have said previously the county does not have the means or the mandate to take control of the hospital, which serves residents on private insurance plans as well as the uninsured and those on Medicare and Medi-Cal.

County Supervisor John Gioia, an energetic proponent of Measure C, said Wednesday that the health care district board will meet later this month to discuss closure options.

"At this point, the hospital's only chance of survival would involve multiple health care partners stepping forward to financially support it," Gioia wrote in an email.

Measure C would have generated an estimated $20 million annually for the hospital, which is hemorrhaging about $1.5 million every month despite cost-cutting and new revenues that have cut the operating deficit in half in recent years.

State law requires 90 days notice to the community before an emergency room can be closed, so the health care board must act soon to close by early August, which is when hospital officials project that operating cash will run out.

Representatives from both Kaiser and Sutter released statements lamenting the failure of Measure C, but neither gave any indication that those providers would pony up funds to keep DMC open.

"Going forward, there must be a redesigned, sustainable health care delivery system in West Contra Costa. For example, urgent and primary care services could be expanded so residents don't have to rely on emergency rooms for their care," Kaiser Senior Vice President Claude Watts said in an email.

DMC, which opened 60 years ago as Brookside Hospital, provides roughly 80 percent of inpatient hospital capacity and nearly 60 percent of emergency-room care within its West Contra Costa service area.

Helen Hunt, a 62-year-old El Sobrante resident, was at the hospital Wednesday visiting her husband, who was recovering from intestinal surgery.

"I don't even want to think what is going to happen to us if this hospital isn't here," she said. "We are hoping for a miracle."